| Condition |
T |
B |
F |
VP |
| Reread words or lines |
X |
X |
|
|
| Reverse letters, numbers or words |
|
|
|
X |
| Poor reading comprehension, difficulty remembering what you’ve read |
X |
X |
X |
X |
| Eyes hurt or feel tired after close work |
X |
X |
X |
|
| Unusually tired after completing a visual task |
X |
X |
X |
|
| Vision blurs at distance when looking up from near work |
|
X |
X |
|
| Poor spelling skills |
|
|
|
X |
| Difficulty with eye‐hand coordination sports such as baseball |
X |
X |
|
X |
| Poor word recall & recognition |
|
|
|
X |
| Uses fingers to count for math |
|
|
|
X |
| Difficulty following instructions (written or verbal) |
|
|
|
X |
| Below grade level on standardized tests |
X |
X |
X |
X |
| Feel sleepy while reading |
X |
X |
X |
|
| Confuse right and left directions |
|
|
|
X |
| Car sickness or motion sickness |
X |
X |
X |
|
| Watery eyes |
X |
X |
X |
|
| Sensitivity to light |
X |
X |
X |
|
| Red eyes |
X |
X |
X |
|
| Totals |
25 |
28 |
22 |
23 |
| Maximum Possible |
69 |
84 |
54 |
55 |
